The Border Mail – Australia 30 August 2007
SEVERELY obese Australians should have access to cheap lap-band surgery to lengthen life and reduce the weight burden on the health system, obesity experts say.

Specialists are urging the Federal Government to make Medicare rebates available for the controversial stomach surgery, after international studies confirmed it could cut death rates.

Research from the US and Sweden released this week showed obese people who underwent the procedure had a mortality rate up to 40 per cent lower than their bandless counterparts.

Public health specialists say mounting evidence supports making lap-band surgery more widely and cheaply available for Australians with an extreme weight problem.

Access in the public health system is very limited.

Almost all of the 8000 people who get the adjustable band fitted each year pay up to $10,000 to have it done privately.

Professor John Dixon, from the Centre for Obesity Research at Monash University in Melbourne, said it was time to act now to make lap-band surgery publicly funded and widely available.

While it was expensive, the surgery had been proven beyond a doubt to be cost-effective, he said.

“It extends life, improves quality of life and severely limits the risk of developing diabetes, heart problems and other disease, but we have been slow to act on that knowledge,� he said.

Professor Dixon said about 8 per cent of adult Australians were obese, with a body mass index over 35, making them eligible for lap-band surgery.

“We’ve got to be realistic. That is what health is about,� he said.

Women in the UK are more likely to have plastic surgery to please their partners, according to Dr Debra Gimlin, a sociology lecturer at Aberdeen University. She said American women were more likely to have the surgery for themselves.

She interviewed 20 American and 40 British women ranging from 23 to 52 years old.

She said: “All my respondents were concerned with their physical attractiveness, but only the British women said that they had undergone cosmetic surgery to suit the desires of a particular man.

“I found that British women who have cosmetic surgery have a greater tendency to blame others for their decision.”

In some cases, Dr Gimlin said, the men made their views abundantly clear through offers to pay for the procedure or snide comments about the woman’s appearance. She said: “One British barmaid told me that her husband’s criticism of her figure prompted her decision to have abdominoplasty.

“She said it wouldn’t have entered her mind otherwise, but after she’d had her second child her husband said ‘I love the wee ones but I wish having them hadn’t ruined your figure’.”

In other cases, Dr Gimlin said she found that British women had cosmetic surgery in the hope of cementing their partnership. She said: “A book keeper explained that she probably wouldn’t have had a breast enhancement if it hadn’t been for her partner.

The British sample consisted of 20 women living in Scotland and 20 in the South West of England. The Americans lived on Long Island, New York. Her findings also suggest British women are more inclined to keep their surgery a secret from family and friends.

The British Association of Aesthetic Plastic Surgeons said people should not feel pressurised and women should consider what could be a serious surgical procedure carefully.

Banbury Guardian 29 August 2007

A MOTHER who is sporting a whole new look after undergoing major plastic surgery will be baring all on national television.

Salena Newport, 40, of Adderbury is appearing on Channel 4 makeover programme 10 Years Younger on Thursday, August 30, where viewers will see the results of her extensive operations.

Mrs Newport – who used to weigh 231/2 stone and wore size 32 clothes – lost 121/2 stone in 2005 after paying £5,000 to have a gastric band fitted.

But the dramatic weight loss left her with baggy, excess skin.
As part of the popular TV show, which aims to make participants look ten years younger, Mrs Newport had loose skin cut from her arms and thighs, a complete lower body lift, breast uplift and implants, a nose job and new teeth.

23 August 2007

The average adult in the UK is drinking an extra day’s worth of calories every week through alcohol, according to a study by Standard Life.

The average adult is drinking enough lager, wine, cider and spirits to add almost 3,000 calories to their weekly calorific intake.

This is the equivalent to 500 calories above the average male recommended daily limit of 2,500 calories and 50% more than the advised maximum of 2,000 calories a day for a woman.

Annually UK adults are drinking around 155,000 calories through alcohol, adding to the country’s growing obesity problems. With 3,500 extra calories creating one pound of fat, adults are drinking enough alcohol each year to add 44lbs to their bodyweight, or just over three stone.

Men are downing the most calories through alcohol, just short of 200,000 calories annually. On a weekly basis men are consuming 3,836 calories through drink which equates to one and a half days of extra calories a week. Normal strength lager (3% proof) and Continental lager (around 5%) are men’s favourite alcoholic drinks, closely followed by wine and spirits.

But the study found that women are not far behind men in the alcohol adding calorie stakes. The average female is drinking more than 2,100 calories through drink each week which adds up to 110,000 each year. Small and large measures of red and white wine are the main source of alcohol calories for women followed by spirits, lager and alcopops.

Mick James, Protection Marketing Manager for Standard Life said: “These numbers paint a stark picture of how Britain is heading towards alcoholic induced obesity. With clear links to the incidence of diabetes, hypertension, heart attack and other cardiovascular conditions, obesity is of growing concern to public health. There is also a degree of evidence to suggest obesity has actually been reversing the improvements in mortality, made as a result of improvements to medicine. Society seems to be making choices to shorten its life expectancy.�

more  at http://www.easier.com/view/Lifestyle/Health_and_Fitness/Health/article-135300.html

History
The Vertical Sleeve Gastrectomy procedure (also called Vertical Gastrectomy, Sleeve Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction, Logitudinal Gastrectomy and even Vertical Gastroplasty) is performed by approximately 20 surgeons worldwide.  This forum is titled “VSG forum� to include the two most common terms for the procedure(vertical and sleeve).   The earliest forms of this procedure were conceived of by Dr. Jamieson in Australia(Long Vertical Gastroplasty, Obesity Surgery 1993)- and  by Dr. Johnston in England in 1996 (Magenstrasse and Mill operation- Obesity Surgery 2003).  Dr Gagner in New York, refined the operation to include gastrectomy(removal of stomach) and offered it to high risk patients in 2001.  Several surgeons worldwide have adopted the procedure and have offered it to low BMI and low risk patients as an alternative to laparoscopic banding of the stomach.

It generates weight loss by restricting the amount of food (and therefore calories) that can be eaten by removing 85% or more of the stomach without bypassing the intestines or causing any gastrointestinal malabsorption.  It is a purely restrictive operation.  It is currently indicated as an alternative to the Lap-Band® procedure for low weight individuals and as a safe option for higher weight individuals.

full article http://www.obesityhelp.com/forums/vsg/cmsID,8874/mode,content/a,cms/

All businesses are used to dealing with absences due to illness. But the issue of how to handle attendance and performance issues caused by elective medical procedures is less clear cut.

With about 28,900 cosmetic procedures carried out in 2006, and one-in-seven couples with fertility problems, it’s an increasingly pertinent issue. Would you, for example, treat an employee undergoing chemotherapy in the same way as you would treat an employee undergoing a course of IVF? Similarly, is the employee recovering from their breast augmentation afforded the same rights as the employee recuperating from heart surgery?

Are employees who choose to have elective procedures entitled to sick pay?

An employee is entitled to statutory sick pay (SSP) when they are unfit to work, as the reason for their absence is essentially immaterial. Provided they follow the requisite notification requirements, then SSP is payable. Staff undergoing fertility treatment are, however, not entitled to SSP unless the effect of that treatment – such as stress or depression – means they are unfit for work.

full article http://www.contractjournal.com/Articles/2007/08/22/55991/legal+q.html

Studies of stomach-surgery patients offer the strongest evidence yet that shedding pounds can extend life.
Obese people are significantly less likely to die if they undergo stomach surgery to lose weight, according to two new studies that offer the first convincing evidence that the health gains of losing weight translate into living longer.
The research, involving 20,000 obese people in the United States and Sweden, found that those who underwent surgery had a 30 percent to 40 percent lower risk of dying over the next seven to 10 years compared with those who went without the operations.
Previous research has shown that losing weight cuts the risk of diabetes, heart disease, cancer, and other major ailments and suggested that might lead to an increase in longevity. But the new studies offer the strongest evidence to date in answer to one of the most important and contentious questions about one of the western world’s biggest health problems: Does weight loss result in not only healthier lives but also longer ones?
“The question as to whether intentional weight loss improves life span has been answered,” wrote George Bray of the Pennington Biomedical Research Center in Baton Rouge, La., in a commentary accompanying the reports in today’s New England Journal of Medicine.
“The answer appears to be a resounding yes.”

“Morbid obesity is a disease. Bariatric surgery is the only efficient treatment of morbid obesity. It is a matter of life and death. The results of this major scientific study will, I hope, contribute to eliminate the preconceived ideas against morbidly obese persons and bariatric surgery”, says Jennifer Schultz, cofounder of the Coalition against Morbid Obesity . “This study effectively shows the beneficial impact of bariatric surgery on the health and survival of morbidly obese people.”
Morbid obesity is the starting point for different types of diseases that are often fatal, such as arterial hypertension, Type 2 diabetes, or heart disease. An individual’s obesity level can be evaluated by means of the body mass index (BMI), which is calculated by dividing the person’s weight by his or her height squared (Kg/m(2)). Morbid obesity corresponds to a BMI higher than or equal to 40, or higher than or equal to 35 if accompanied by comorbidities.
According to the World Health Organization (WHO), bariatric surgery is considered to be the only effective treatment for morbid obesity. Bariatric surgery includes a series of techniques that are based on two intervention principles: Restriction and Malabsorbtion. Restrictive procedures include Gastric Banding (the lap band) and the relatively new technique of Vertical Sleeve Gastrectomy, which is producing some very encouraging results. Malabsorptive procedures include Gastric Bypass and Duodenal Switch.

There are two Metabolic Hormones Controlling Appetite, Leptin and Grehlin

Leptin:
Discovered in 1994, signals the brain that the body has had enough to eat.
The earliest-discovered of these hormones, and the first hormone ever shown to have a direct role in appetite and weight control. The hormone is secreted in fatty tissue and released into the bloodstream.  However, as the amount of fatty tissue in the body increases, the body begins to “resist� the leptin.  Obese people often have extremely high levels of leptin circulating in the blood.  However, the brain “ignores� the leptin because  it has become desensitized to it.  For this reason, injecting leptin into obese people to “curb� their appetite has been shown to be ineffective.  Also, if obese people reduce fatty tissue by losing weight, it is not clear whether the brain ever recovers its normal sensitivity to leptin.

Conclusion:
Once someone becomes obese and leptin-resistent,  automatic self-regulating appetite
control is no longer possible.

Grehlin:
Discovered in 1999, signals the brain to increase feelings of hunger.
Discussion:
Ghrelin is the only major metabolic hormone not secreted in fatty tissue– it is secreted in the lining of the stomach.  In obese people, Ghrelin levels tend to be high, increasing the apparent feeling of hunger.  Also, Ghrelin levels apparently fail to “cycle� up and down over a 24 hour period, as occurs with thinner people.

Gastric Bypass Surgery and Sleeve Gastrectomy: These types of surgery block part of the stomach, reducing the area of stomach lining being actually used.  Because there is less stomach lining, there is less ghrelin being secreted too, resulting in reduced hunger.

Anti-Obesity Vaccine– controlling ghrelin:  Scripps Research Institute reported in August 2006 that it had broken through with the first anti-obesity vaccine.  Still at a very early stage, Scripps scientists injected mature male rats with a vaccine which acted against ghrelin.  The vaccine stimulates the body to produce antibodies which attack or block the ghrelin being secreted.
This finding may be especially important to stop what is commonly known as “yo-yo dieting,� the cycle of repeated loss and regain of weight experienced by many dieters.

These findings may mark a turning point in the treatment of obesity by using the body’s own immune system to combat chronic obesity by the use of targeted antibodies.

No human trials have yet been reported.

By CTK / Published 20 August 2007
Prague, Aug 18 (CTK) – Czech plastic surgeon Bohdan Pomahac from Olomouc, north Moravia, has become head of a U.S. team that will become the third one in the world to transplant faces, Mlada fronta Dnes (MfD) writes today.

Another such workplace is only in France. It transplanted the face of a woman whom a dog bit out a cheek, the lips and the nose.

“The third clinic is in China but the doctors have not released any detailed data on the operations, so it is difficult to say how successful they are,” Pohamac, 36, told the paper.

He will head the burns clinic of Brigham and Women’s Hospital in Boston. At the same time he heads a team that will perform face transplants there.

The hospital has long been one of the ten best facilities in the United States where patients from all over the world are treated. One storey with luxury equipment is reserved for rich patients.

Story from Prague Daily Monitor 20/08/07

By Jane Elliott
BBC News, health reporter
Lou Hunneybel hated her 38G breasts – they were too big and caused her daily agony.
Her shoulders and back ached from the excessive weight and she had an uncomfortable fungal rash underneath caused by excessive sweating.
Her GP told her she needed to lose at least a stone and a half (9.5kg) in weight before she would be considered for surgery.
She lost two stones (12.7 kg), but no weight went from her breasts leaving her a dress size 14 (European 40, US 12) on the bottom and size 22 (European 48, US 20) on the top.
Her GP then referred her for surgery, but without seeing her, the local primary care trust (PCT) immediately refused treatment.
“I was just so upset. My GP had referred me and said that I had problems, but they just sent me a letter saying that it was cosmetic surgery so I could not even have a consultation on the NHS.
“But it was not just cosmetic, I was in real discomfort. It was so uncomfortable.
“I had a huge thrush rash underneath them, which was very sore.
“My husband, Andrew, was so cross when they refused me that he took pictures of my breasts and the rash and posted them to the PCT.
“We knew I needed the operation and I needed them to see my problems.
“He blew the pictures up to A4 size and sent them in the post.”
Within weeks of sending the photos, 36-year-old Lou, from Essex, was given a consultation date and just months later she had her NHS surgery.
More: http://news.bbc.co.uk/1/hi/health/6688353.stm